Provider Demographics
NPI:1427320217
Name:DETTMANN, BRAD (RPH)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:DETTMANN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 N NEWPORT HWY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1219
Mailing Address - Country:US
Mailing Address - Phone:509-466-7414
Mailing Address - Fax:509-466-0546
Practice Address - Street 1:9520 N NEWPORT HWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1219
Practice Address - Country:US
Practice Address - Phone:509-466-7414
Practice Address - Fax:509-466-0546
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist